barriers to alcohol addiction treatment in women and men experiencing alcohol addiction in a thai PDF
Preview barriers to alcohol addiction treatment in women and men experiencing alcohol addiction in a thai
Mälardalen University Press Dissertations No. 218 Mälardalen University Press Dissertations No. 218 BARRIERS TO ALCOHOL ADDICTION TREATMENT IN WOMEN AND MEN EXPERIENCING ALCOHOL ADDICTION IN A THAI CONTEXT BARRIERS TO ALCOHOL ADDICTION TREATMENT IN WOMEN AND EMXEPLNO REIXNGP ELIRVEIEDN ECXPINERGIE ANCLECSO AHNOD LH EAADLTDHICCATRIEO PNR OINV IADE TRHS’A PIE CRSOPNECTTEIVXETS EXPLORING LIVED EXPERIENCES AND HEALTHCARE PROVIDERS’ PERSPECTIVES Kulnaree Hanpatchaiyakul 2016 Kulnaree Hanpatchaiyakul 2016 School of Health, Care and Social Welfare School of Health, Care and Social Welfare Copyright © Kulnaree Hanpatchaiyakul, 2016 ISBN 978-91-7485-297-4 ISSN 1651-4238 Printed by Arkitektkopia, Västerås, Sweden Mälardalen University Press Dissertations Mälardalen UniveNrosi. t2y1 8Press Dissertations No. 218 BARRIERS TO ALCOHOL ADDICTION TREATMENT IN WOMEN AND MEN EXPERIENCING ALCOHOL ADDICTION IN A THAI CONTEXT EXPLORING LIVED EXPERIENCES AND HEALTHCARE PROVIDERS’ PERSPECTIVES BARRIERS TO ALCOHOL ADDICTION TREATMENT IN WOMEN AND MEN EXPERIENCING ALCOHOL ADDICTION IN A THAI CONTEXT Kulnaree Hanpatchaiyakul EXPLORING LIVED EXPERIENCES AND HEALTHCARE PROVIDERS’ PERSPECTIVES Akademisk avhandling som för avläggande av filosofie doktorsexamen i vårdvetenskap vid Akademin för hälsa, vård och vKälufälnrda rkeoem Hmaenr paattt cohffaeniytlaigkeunl försvaras fredagen den 9 december 2016, 13.15 i Raspen, Mälardalens högskola, Eskilstuna. 2016 Fakultetsopponent: Professor Margaretha Strandmark, Karlstad University Copyright © Kulnaree Hanpatchaiyakul, 2016 ISBN 978-91-7485-297-4 Akademin för hälsa, vård och välfärd ISSN 1651-4238 Printed by Arkitektkopia, Västerås, Sweden School of Health, Care and Social Welfare Abstract Risky drinking behaviour can strongly influence the lives of individuals and families, including having negative effects on social welfare and health. The low rate of healthcare service use among people experiencing alcohol addiction is an important problem in Thai society. The overall aim of the study was to explore the barriers to alcohol treatments for people experiencing alcohol addiction. This thesis includes four qualitative studies that employed three different data collection methods. Individual interviews were used in studies I and II and were analysed with descriptive phenomenology. Focus group interviews were conducted in study III, and the Delphi method was applied in study IV. Both of the latter studies employed content analysis. Purposive sampling was applied to identify participants for the four studies, which included 13 men (study I) and 12 women (study II) experiencing alcohol addiction, 32 healthcare providers (study III) and 32 experts in the alcohol treatment field (study IV); the providers and experts were primarily nurses (study III and IV). The identified barriers at the individual level included the unawareness of alcohol addiction, gender differences in treatment and in society, the experienced stigma related to alcohol addiction and the lack of engagement in alcohol treatment. Barriers at the organizational level were related to healthcare providers’ agencies and engagement, vertical and horizontal collaborative practices within the hospital wards, and the collaboration with patients and their next of kin. Additionally, the struggle of handling the different sexes during treatment and the difficulties of using the required standard methods were described by the healthcare providers. At the structural level, the barriers were related to the patriarchal society, gender equity and the resources and funding from the Ministry of Public Health for improving the well-being and equal healthcare rights of people experiencing alcohol addiction in Thailand. In order to improve equal rights to health for people experiencing alcohol addiction in Thailand, knowledge of alcohol addiction, stigma and domestic violence related issues needs to be improved in the healthcare service system. Formal training and nurse educational programmes are needed to reach the theoretical and practical potential of nurses and of other healthcare providers working in alcohol addiction. Key words: alcohol addiction, gender perspective, lived experiences, alcohol dependency, focus- group interviews, Delphi study ISBN 978-91-7485-297-4 ISSN 1651-4238 Education is the most powerful weapon which you can use to change the world Nelson Mandela Abstract Background: Risky drinking behavior can strongly influence the lives of in- dividuals and families, including having negative effects on social welfare and health. The low rate of healthcare service use among people experiencing al- cohol addiction is an important problem in Thai society. Aim: The overall aim of the study was to explore the barriers to alcohol ad- diction treatments for people experiencing alcohol addiction. Methods: This thesis includes four qualitative studies that employed three different data collection methods. Individual interviews were used in studies I and II and were analyzed with descriptive phenomenology. Focus group in- terviews were conducted in study III, and the Delphi method was applied in study IV. Both of the latter studies employed content analysis. Purposive sam- pling was applied to identify participants for the four studies, which included 13 men (study I) and 12 women (study II) experiencing alcohol addiction, 32 healthcare providers (study III) and 32 experts in the alcohol addiction treat- ment field (study IV); the healthcare providers and experts were primarily nurses (studies III and IV). Results: The identified barriers at the individual level included the unaware- ness of alcohol addiction, gender differences in treatment and in society, the experienced stigma related to alcohol addiction and the lack of engagement in treatment. Barriers at the organizational level were related to healthcare pro- viders’ agencies and engagement, vertical and horizontal collaborative prac- tices within the hospital wards, and the collaboration with patients and their next of kin. Additionally, the struggle of handling the different sexes during treatment and the difficulties of using the required standard methods were de- scribed by the healthcare providers. At the structural level, the barriers were related to the patriarchal society, gender equity and the resources and funding from the Ministry of Public Health for improving the well-being and equal healthcare rights of people experiencing alcohol addiction in Thailand. Conclusion: The findings of this thesis suggest that changes have to be made on at least three levels of Thai society to cope with the increasing problem of alcohol addiction. In order to improve equal rights to health for people expe- riencing alcohol addiction in Thailand, knowledge of alcohol addiction, stigma and domestic violence related issues needs to be improved in the healthcare service system. Formal training and nurse educational programs are needed to reach the theoretical and practical potential of nurses and of other healthcare providers working in alcohol addiction. Key words: alcohol addiction, gender perspective, lived experiences, alcohol dependency, Delphi study, focus group interview List of Papers This thesis is based on the following papers, which are referred to in the text by their Roman numerals. I Hanpatchaiyakul, K., Eriksson, H., Kijsomporn, J. Östlund, G. (2014). Thai Men's Experiences of Alcohol Addiction and Treatment. Global Health Action, 7: 23712. doi: 10.3402/gha.v7.23712 II Hanpatchaiyakul, K., Eriksson, H., Kijsomporn, J., Östlund, G. Lived experience of Thai women with alcohol addiction. Submitted to Health Care for Woman International III Hanpatchaiyakul, K., Eriksson, H., Kijsomporn, J., Östlund, G. (2016). Healthcare providers’ experiences of working with alcohol addiction treatment in Thailand. Contemporary Nursing. 52:1, 59-73. DOI: 10.1080/10376178.2016.1183461 IV Hanpatchaiyakul, K., Eriksson, H., Kijsomporn, J., Östlund, G. (2016). Barriers to successful treatment of alcohol addic- tion perceived by healthcare professionals in Thailand- a Del- phi study about obstacles and improvement suggestions. Global Health Action, 9: 31738- doi.org/10.3402 /gha.v9.31738 Reprints were made with permission from the respective publishers. Contents Introduction ..................................................................................................... 8 Background ..................................................................................................... 9 Thai UHC and the barriers to alcohol treatment ........................................ 9 Health and welfare perspectives .......................................................... 10 Thai healthcare services for alcohol addiction .................................... 12 Thai local wisdom and Buddhists’ alcohol treatment .......................... 13 Application of Western treatment programmes in the healthcare system ............................................................................................................. 14 Gender and alcohol consumption in a Thai context ............................ 15 Individuals experiencing alcohol addiction .............................................. 16 Described challenges in working with people experiencing alcohol addiction ................................................................................................... 18 Concepts and framework .......................................................................... 18 Phenomenology ................................................................................... 18 Gender perspective .............................................................................. 20 Rationale ....................................................................................................... 22 Aims .............................................................................................................. 23 Methods ........................................................................................................ 24 Individual interviews ................................................................................ 25 Focus group interviews ............................................................................ 28 Delphi methodology ................................................................................. 31 Ethical considerations ................................................................................... 34 Results ........................................................................................................... 35 Lived experiences of men......................................................................... 35 Lived experiences of women .................................................................... 36 Healthcare providers’ perspectives on alcohol treatment ......................... 38 Experts panel suggestions for improving alcohol addiction treatment..... 39 Discussion ..................................................................................................... 42 Barriers on the individual level ................................................................ 42 Barriers to organization ............................................................................ 45 Barriers on the structural level ................................................................. 48 Trustworthiness ........................................................................................ 50 Description of contributions ..................................................................... 54 Conclusions ................................................................................................... 55 Future directions ........................................................................................... 56 Summary in Swedish .................................................................................... 57 Summary in Thai .......................................................................................... 59 Acknowledgements ....................................................................................... 61 References ..................................................................................................... 63 Apendix Paper I Paper II Paper III Paper IV
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